MEDICARE: ALAN JAY ROTH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000696	PA

General Provider Information

NPI Number	:	1962599944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN JAY ROTH O.D.

Provider Business Mailing Address
First Line	:	700 POWDER MILL LN
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-4035
Country	:	US
Telephone Number	:	610-642-0801
Fax Number	:	215-546-1943

Provider Business Practice Location Address
First Line	:	1315 WALNUT ST
Second Line	:	AMERICAS BEST
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4719
Country	:	US
Telephone Number	:	215-546-1666
Fax Number	:	215-546-1943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/08/2007

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